Proportion and patterns of ocular disorders among under‐five children in Khartoum State, Sudan: A cross‐sectional study

Early childhood is an important period for children's health and development. In addition to physical wellbeing, healthy development of a child is when social, emotional and educational needs are met. Ocular diseases among children are related to prenatal‐, neonatal‐, or childhood‐underlying causes. Ocular diseases at a young age might significantly affect children's development and eventually interfere with their quality of life. Visual defects and blindness among young children are a major concern, as they have numerous negative impacts on individuals, the community, and the country. Globally, it is estimated that one child goes blind every minute and 60% die within 1–2 years of becoming blind. The majority of blind children are in poor African and Asian countries. Conjunctivitis and refractive errors (REs) are the most common pediatric ocular diseases, whereas congenital cataracts remain the most common treatable blinding disorder in infancy and childhood. Other common pediatrics ocular diseases include retinopathy of prematurity (ROP), optic atrophy, advanced glaucoma, anophthalmos, retinal detachment, keratomalacia with perforation, corneal opacities, and myopia. The detection of ocular diseases is crucial for effective interventions and, therefore, vision screening programs for young children are highly recommended. However, there are barriers in conducting these programs in developing countries due to scarcity of trained professionals and low enrolment in screening programs. As a result, the majority of young children never get an eye examination. The majority of ocular disorders such as amblyopia, unilateral blindness, and strabismus occur at a young age and is the reason why the American Academy of Pediatrics recommends visual screening programs for children younger than 5 years to ensure early detection and appropriate interventions, which, in turn, result in a better quality of life. The objective of this research was to study the epidemiological patterns of ocular morbidity among children younger than 5 years old at three tertiary eye hospitals.


| INTRODUCTION
Early childhood is an important period for children's health and development. In addition to physical wellbeing, healthy development of a child is when social, emotional and educational needs are met. 1 Ocular diseases among children are related to prenatal-, neonatal-, or childhood-underlying causes. 2 Ocular diseases at a young age might significantly affect children's development and eventually interfere with their quality of life. [3][4][5][6][7] Visual defects and blindness among young children are a major concern, as they have numerous negative impacts on individuals, the community, and the country. Globally, it is estimated that one child goes blind every minute and 60% die within 1-2 years of becoming blind. 2 The majority of blind children are in poor African and Asian countries. 2 Conjunctivitis and refractive errors (REs) are the most common pediatric ocular diseases, 8 whereas congenital cataracts remain the most common treatable blinding disorder in infancy and childhood.
Other common pediatrics ocular diseases include retinopathy of prematurity (ROP), 9 optic atrophy, advanced glaucoma, anophthalmos, retinal detachment, keratomalacia with perforation, corneal opacities, and myopia. 10 The detection of ocular diseases is crucial for effective interventions and, therefore, vision screening programs for young children are highly recommended. 11 However, there are barriers in conducting these programs in developing countries due to scarcity of trained professionals and low enrolment in screening programs. As a result, the majority of young children never get an eye examination. The majority of ocular disorders such as amblyopia, unilateral blindness, and strabismus occur at a young age and is the reason why the American Academy of Pediatrics recommends visual screening programs for children younger than 5 years to ensure early detection and appropriate interventions, which, in turn, result in a better quality of life. 12 The objective of this research was to study the epidemiological patterns of ocular morbidity among children younger than 5 years old at three tertiary eye hospitals. Independent-sample T test was conducted to examine any significant difference across patterns of ocular disorders between boys and girls.

| METHODS
A p < 0.05 was considered as significant. Computerized patient records were never left unattended during data collection and data were directly entered into a password-protected electronic database.

Ethical approval was obtained from Al-basar Institutional Review
Board (B-IRB-20-MR-012) and permission to access the data was obtained from each of the three hospital's administration. All necessary measures were taken to ensure anonymity of the patients and hospital, and all collected information is confidential.

| RESULTS
Under 5-year-old children constituted 45% of the total number of children younger than 16 years (n = 4899) treated at the sites.
Boys to girls ratio was (1.1:1). The age group that was most affected with ocular morbidity was those 3-5 years old (53%, There was some variation in morbidity according to gender (  In this study, children younger than 5 years of age constituted just less than half of the total number of children-younger than 16 years-treated at the three study sites. These results are similar to an Ethiopian study, which reported a prevalence of 32% of ocular morbidity affecting under-five children. 13 The study revealed different patterns of ocular diseases from simple to blinding diseases. The most common ocular disease in this study was bacterial, viral and fungal infections. Although most of these infections do not cause permanent damage, some might lead serious visual defects if not treated at an early stage. In most cases, urgent referral to an ophthalmologist for proper diagnosis and treatment is suggested. 14 Eye infections among young children were the most frequent ocular disorders accounted for about 40% as reported in a similar hospital based study in Karachi. 13 Allergies were the second most common group of ocular diseases, followed by orbitrelated conditions. In a similar study conducted in Ethiopia, the second commonest eye disorder among young children was ocular allergy. 13 Orbit-related conditions comprising the eyelids, tear ducts, and eyeball represented a substantial proportion of ocular disorders in this study. In general, the commonest form of this group of disorders is naso-lacrimal duct obstruction that can lead to serious complications if left untreated. Infection, which may lead to cellulitis, abscesses and brain involvement if left untreated, remains a major concern. The other form of orbit-related conditions is eyelid swelling, whether inflammatory or due to tumors. Few of the under-five children in this study were diagnosed with tumors, the predominant type being retinoblastoma. Eye tumors are of concern due to the narrow distance between the eyeball and brain, as well as the connection made by the optic nerve and the retina.
These features make secondary involvement likely. Retinoblastoma is the most common eye cancer of childhood but it is a relatively rare disease, occurring in~1 out of every 16,000 to 18,000 live births in the global population. Its incidence is similar across populations and does not vary according to gender, ethnicity, or socioeconomic status. Worldwide,~8000 children develop retinoblastoma each year, with the vast majority presenting with the disease before the age of 5 years. 29 The pattern of ocular diseases in this study is similar to what was reported in a study conducted among Egyptian pre-school children in rural areas, with one exception. Their study reported RE as the most common condition, while this study in it is the fourth most common condition. 30 The pattern of ocular diseases between the genders showed some variation in this study and the overall finding that boys appear to be disproportionally affected supports the results of a study conducted by Demissie et al. 31 Gender variations in ocular health are clinically under-addressed. 32 Although there are evidence of gender disparities with regard to some ocular diseases prevalent for adult women more than men related to some biological and cultural factors, there are no available data in regard to younger children. The gender variation in this study could be coincidently but still need to be addressed and further studies are needed to clarify any clinical significance. 33 8 | CONCLUSION